PATENT APPLICATION FEE DETERMINATION RECORD
Effective October 1 , 2001
Application or Docket Number
TOTAL CLAIMS
CLAIMS AS FILED - PART I
(Column 1)
FOR
TOTAL CHARGEABLE CLAIMS
INDEPENDENT CLAIMS
T
NUMBER FILED
7
minus 20=
7M
minus 3 =
NUMBER EXTRA
MULTIPLE DEPENDENT CLAIM PRESENT
□
* If the difference in column 1 is less than zero, enter "0" in column 2
CLAIMS AS AMENDED • PART II
(Column 1)
(Column 2)
(Column 3)
ENTA j
CLAIMS )
REMAINING
AFTER
AMENDMENT
HIGHEST
NUMBER
PREVIOUSLY
PAID FOR
PRESENT
EXTRA
5
Q
Z
Total
★
Minus
**
LU
s
Independent
★
Minus
<
FIRST PRESENTATION OF MULTIPLE DEPENDENT CLAIM □
(Column 1)
(Column 2)
(Column 3)
ENTB |
CLAIMS
REMAINING
AFTER
AMENDMENT
HIGHEST
NUMBER
PREVIOUSLY
PAID FOR
PRESENT
EXTRA
5
Q
Z
Total
Minus
**
LU
s
Independent
★
Minus
<
FIRST PRESENTATION OF MULTIPLE DEPENDENT CLAIM
□
(Column 1)
(Column 2)
(Column 3)
ENTC J
| CLAIMS
REMAINING
I AFTER
AMENDMENT
| HIGHEST
NUMBER
PREVIOUSLY
I PAID FOR
PRESENT
EXTRA
2
Q
Z
Total
*
Minus
★*
LU
s
Independent
*
Minus
<
FIRST PRESENTATION OF MULTIPLE DEPENDENT CLAIM
□
* If the entry in column 1 is less than the entry in column 2. write "0" in column 3.
** If the "Highest Number Previously Paid For" IN THIS SPACE is less than 20. enter "20.'
*lf the "Highest Number Previously Paid For" IN THIS SPACE is less than 3, enter "3."
SMALL ENTITY
TYPE
OTHER THAN
OR SMALL ENTITY
RATE
FEE
RATE
FEE !
BASIC FEE
370.00
OR
BASIC FEE
740.00
X$9=
OR
X$18=
X42=
OR
X84=
+140=
OR
+280=
TOTAL
OR
TOTAL
SMALL 1
ENTITY
OR
OTHER THAN
SMALL ENTITY
RATE
ADDI-
TIONAL
FEE
RATE
ADDI-
TIONAL
FEE
X$ 9=
OR
X$18=
X42=
OR
X84=
+140=
OR
+280=
TOTAL
OR
TOTAL
ADDIT. FEE
RATE
TIONAL
FFF
ILL-
RATE
ADDI-
TIONAL
FEE
X$9=
OR
X$18=
X42=
OR
X84=
+140=
OR
+280=
TOTAL
ADD IT FEE
OR
TOTAL
RATE
ADDI-
TIONAL
FEE
I RATE
ADDI-
TIONAL
FEE
X$9=
OR
X$18=
X42=
OR
X84=
+140=
OR
+280=
TOTAL
ADDIT. FEE
OR
TOTAL
ADDIT. FEE
ll u I I ly I igoi null iuvi ■ i wwiwviwi j > mim ■ wi . ■ » ■ * iiw v> • *w ■ — • — i —
The "Highest Number Previously Paid For" (Total or Independent) is the highest number found in the appropriate box in column 1 .
FORMPTO-875 (Rev. 8/01)
Patent and Trademark Office, U.S. DEPARTMENT OF COMMERCE
•A-U S OPO 2001 482- 1*4/ 59197